Introduction
Materials and methods
Study design
n | Community hospital (n = 210) | Private hospital (n = 123) | University hospital (n = 190) | |
---|---|---|---|---|
domain patient characteristics | ||||
age in years (mean, SD) | 523 | X | X | X |
age more than 65 years | 523 | X | X | X |
gender masculine | 523 | X | X | X |
living single at home | 182 | X | X | |
units of alcohol per day | 230 | X | X | |
daily use of alcohol | 496 | X | X | X |
daily use of more than three units of alcohol | 230 | X | X | |
number of cigarettes per day | 221 | X | X | |
daily smoking | 519 | X | X | X |
daily smoking of more than 10 cigarettes | 217 | X | X | |
domain chronic pathology | ||||
predisposing cognitive impairment | 384 | X | X | X |
predisposing cardiac disease | 265 | X | X | |
predisposing pulmonary disease | 262 | X | X | |
domain acute illness
| ||||
length of stay in the ICU before inclusion | 523 | X | X | X |
length of stay in the ICU before inclusion >1 day | 523 | X | X | X |
length of stay in the ICU before inclusion >2 days | 523 | X | X | X |
admission for internal medicine | 523 | X | X | X |
high risk of mortality (SAPS >40; APACHE > 24) | 212 | X | X | |
APACHE II | 120 | X | X | |
SAPS II | 108 | X | ||
highest TISS 28 score | 179 | X | X | |
mean TISS 28 | 179 | X | X | |
TISS 28 cut off 30 (318 minutes) | 279 | X | X | |
psychoactive medication | 424 | X | X | X |
benzodiazepine | 283 | X |
X(low response)
| X |
morphine | 287 | X |
X(low response)
| X |
sedation | 228 | X |
X(low response)
| X |
endotracheal tube or tracheastomy | 390 | X | X | |
gastric tube | 395 | X | X | |
bladder catheter | 400 | X | X | |
arterial catheter | 398 | X | X | |
number of perfusions | 400 | X | X | |
more than three perfusions | 398 | X | X | |
number of vascular catheters | 400 | X | X | |
no normal food | 395 | X | X | |
fever | 397 | X | X | |
domain environmental factors
| ||||
admission via emergency room | 377 | X | X | |
admission via transfer | 377 | X | X | |
open room in intensive care | 508 | X | X | X |
isolation | 523 | X | X | X |
no visible daylight | 523 | X | X | X |
no clock present or visible | 523 | X | X | X |
number of visitors | 256 | X | X | X |
no visit | 269 | X | X | X |
physical restraints | 292 | X | X |
Delirium assessment
Assessment of the risk factors
Statistical approach and analysis
Results
Total population | Community hospital | Private hospital | University hospital | P value | ||
---|---|---|---|---|---|---|
N | 523 | 210 | 123 | 190 | ||
age in years | mean (range) | 64 (19 to 90) | 65 (19 to 90) | 67 (26 to 87) | 60 (20 to 90) | <0.001 |
gender | male | 59% | 61% | 54% | 62% | 0.34 |
admission | surgery | 49% | 26% | 73% | 59% | <0.001 |
internal medicine | 51% | 74% | 27% | 41% | ||
length of stay in days | mean (range) | 8 (1 to 68) | 11 (2 to 68) | 7 (2 to 43) | 8 (1 to 54) | 0.01 |
length of stay before inclusion in days | mean (range) | 3.6 (1 to 63) | 3.9 (1 to 63) | 3.5(1 to 34) | 3.2 (1 to 47) | 0.62 |
NEECHAM | delirium | 29.6% | 38% | 29% | 21% | <0.001 |
early to mild confused | 25.8% | 23% | 33% | 24% | ||
at risk | 19.7% | 10% | 21% | 30% | ||
normal | 24.9% | 29% | 17% | 26% | ||
APACHE II | mean (range) | -------- | 15 (19 to 23) | -------- | 19 (7 to 47) | 0.04 |
SAPS II | mean (range) | -------- | 31 (4 to 73) | -------- | -------- | |
TISS 28 | mean (range) | -------- | 34 (19 to 48) | -------- | 32 (17 to 49) | 0.19 |
capacity of the intensive care units | 25 beds | 24 beds | 34 beds |
Factors related to patient characteristics
n | Mean (SD) or % | univariate | multivariate | ||||
---|---|---|---|---|---|---|---|
D | ND | D | ND | P* | OR (CI) | OR (CI) | |
age in years (mean, SD) | 155 | 368 | 65.0 (16.4) | 63.7 (14.6) | 0.36 | 1.01 (0.99 to 1.02) | |
age more than 65 | 91/155 | 202/368 | 55% | 59% | 0.24 | 1.17 (0.80 to 1.71) | |
gender masculine | 90/155 | 220/368 | 58% | 60% | 0.40 | 0.93 (0.64 to 1.36) | |
living single at home | 45/114 | 38/68 | 56% | 40% | 0.02 | 1.94 (1.06 to 3.57) | |
units of alcohol per day | 58 | 172 | 3.2 (5.2) | 2.1 (3.9) | 0.09 | 1.05 (0.99 to 1.12) | |
daily use of alcohol | 44/142 | 94/354 | 31% | 27% | 0.19 | 1.24 (0.81 to 1.90) | |
daily use of more than three units of alcohol | 21/58 | 32/172 | 36% | 19% | 0.01 | 2.48 (1.29 to 4.80) | 3.23 (1.30 to 7.98) |
number of cigarettes per day | 46 | 175 | 11.4 (13.6) | 6.4 (9.6) | 0.02 | 1.04 (1.01 to 1.07) | |
daily smoking | 33/153 | 98/366 | 22% | 27% | 0.13 | 0.75 (0.48 to 1.18) | |
daily smoking of more than 10 cigarettes | 22/46 | 54/174 | 48% | 31% | 0.03 | 2.04 (1.05 to 3.95) |
Factors related to chronic pathology
n | % | P* | univariate | multivariate | |||
---|---|---|---|---|---|---|---|
D | ND | D | ND | OR (CI) | OR (CI) | ||
predisposing cognitive impairment | 19/107 | 25/277 | 18% | 9% | 0.02 | 2.18 (1.14 to 4.14) | 2.41 (1.21 to 4.79) |
predisposing cardiac disease | 36/72 | 112/193 | 50% | 58% | 0.15 | 0.72 (0.42 to 1.25) | |
predisposing pulmonary disease | 18/72 | 47/190 | 25% | 25% | 0.54 | 1.01 (0.54 to 1.90) |
Factors related to acute illness
n | mean (SD) or % | univariate | multivariate | ||||
---|---|---|---|---|---|---|---|
D | ND | D | ND | P* | OR (CI) | OR (CI) | |
length of stay in the ICU before inclusion* | 155 | 368 | 7.9 (11.5) | 1.7 (2.3) | <0.001 | 1.26 (1.17 to 1.35) | |
length of stay in the ICU before inclusion >1 day* | 87/155 | 116/368 | 56% | 32% | <0.001 | 2.78 (1.89 to 4.09) | |
length of stay in the ICU before inclusion >2 days* | 70/155 | 46/368 | 45% | 13% | <0.001 | 5.77 (3.71 to 8.97) | |
admission for internal medicine | 91/155 | 175/368 | 48% | 59% | 0.013 | 1.57 (1.07 to 2.29) | 4.01 (1.46 to 11.01) |
high risk of mortality (SAPS >40; APACHE >24) | 29/73 | 29/139 | 40% | 21% | 0.003 | 2.50 (1.31 to 4.66) | |
APACHE II | 33 | 87 | 19.7 (7.3) | 18.6 (7.5) | 0.47 | 1.02 (0.97 to 1.08) | |
SAPS II | 54 | 54 | 33.4 (12.6) | 28.6 (10.7) | 0.04 | 1.04 (1.01 to 1.08) | |
highest TISS 28 score | 88 | 191 | 34.9 (5.7) | 31.9 (6.6) | <0.001 | 1.08 (1.04 to 1.13) | |
mean TISS 28 | 88 | 191 | 30.8 (3.9) | 29.1 (5.6) | 0.004 | 1.07 (1.02 to 1.13) | |
TISS 28 cut off 30 (318 minutes) | 68/88 | 104/191 | 77% | 55% | <0.001 | 2.81 (1.60 to 5.05) | |
psychoactive medication | 103/135 | 146/289 | 76% | 51% | <0.001 | 3.15 (1.99 to 4.99) | 3.34 (1.50 to 11.23) |
benzodiazepine | 18/68 | 24/215 | 27% | 11% | 0.003 | 2.89 (1.44 to 5.69) | |
Morphine | 24/70 | 54/217 | 34% | 25% | 0.09 | 1.58 (0.88 to 2.82) | |
sedation | 65/88 | 24/140 | 74% | 17% | <0.001 | 13.66 (7.15 to 26.10) | |
endotracheal tube or tracheastomy | 27/118 | 11/272 | 23% | 4% | <0.001 | 7.04 (3.36 to 14.76) | 8.07 (1.18 to 55.06) |
gastric tube | 44/120 | 19/275 | 37% | 7% | <0.001 | 7.80 (4.30 to 14.16) | |
bladder catheter | 115/120 | 227/280 | 96% | 81% | <0.001 | 5.37 (2.09 to 13.80) | |
arterial catheter | 108/120 | 231/278 | 90% | 83% | 0.05 | 1.83 (0.93 to 3.59) | |
number of perfusions | 120 | 280 | 4.2 (2.0) | 3.1 (1.7) | <0.001 | 1.35 (1.20 to 1.52) | |
more than three perfusions | 65/120 | 81/278 | 54% | 29% | <0.001 | 2.87 (1.85 to 4.47) | 2.74 (1.07 to 7.05) |
number of vascular catheters | 120 | 280 | 1.2 (0.5) | 1.3 (0.6) | 0.18 | 0.74 (0.47 to 1.17) | |
no normal food | 92/120 | 127/275 | 77% | 46% | <0.001 | 3.83 (2.36 to 6.22) | |
fever | 10/119 | 16/278 | 8% | 6% | 0.222 | 1.50 (0.66 to 3.42) |
Factors related to the environment
n | mean (SD) or % | univariate | multivariate | ||||
---|---|---|---|---|---|---|---|
D | ND | D | ND | P* | OR (CI) | OR (CI) | |
admission via emergency room | 60/118 | 119/259 | 51% | 46% | 0.22 | 1.22 (0.79 to 1.88) | |
admission via transfer | 36/118 | 47/259 | 31% | 18% | 0.006 | 1.98 (1.20 to 3.28) | |
open room in intensive care | 52/149 | 98/359 | 35% | 27% | 0.055 | 1.43 (0.95 to 2.15) | |
isolation | 16/155 | 11/368 | 10% | 3% | 0.001 | 3.74 (1.69 to 8.25) | 2.89 (1.00 to 8.36) |
no visible daylight | 70/155 | 118/368 | 45% | 32% | 0.003 | 1.75 (1.19 to 2.56) | 2.39 (1.28 to 4.45) |
no clock present or visible | 19/155 | 36/368 | 12% | 10% | 0.243 | 1.29 (0.71 to 2.33) | |
number of visitors | 88 | 168 | 2.4 (1.9) | 2.5 (2.0) | 0.70 | 0.97 (0.85 to 1.11) | |
no visit | 27/96 | 21/173 | 28% | 12% | 0.001 | 2.83 (1.50 to 5.36) | 3.73 (1.75 to 7.93) |
physical restraints | 25/66 | 4/226 | 38% | 2% | <0.001 | 33.84 (11.19 to 102.36) |
Multivariate model in the four domains
Discussion
Factors related to patient characteristics
Factors related to chronic pathology
Factors related to acute illness
Factors related to the environment
Domains of factors
Study limits
Conclusions
Key messages
-
Predisposing risk factors for delirium are related to patient characteristics and chronic pathology.
-
Precipitating risk factors for delirium are related to acute illness and the environment.
-
Several risk factors are suitable for preventive action.